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It’s pretty difficult to open up a newspaper these days without seeing an article on the devastating public health impact of the opioid epidemic in the United States. While there appears to be general agreement on the scope of the problem, there is less consensus regarding what can be done to solve it. Policy-makers and professional associations taking on this challenge have tended to focus on mortality statistics and/or expert opinion. These are obviously critically important pieces of the puzzle but it is also important to take a patient-centered approach. To facilitate discussion on this important topic, Gallup held a research release event on Sept. 12 in Washington, D.C., titled “Addressing the Opioid Epidemic With Drug-Free Pain Management.”

The first ACA Choosing Wisely® recommendation states: In the absence of red flags, do not obtain spinal imaging (X-rays) for patients with acute low-back pain during the six weeks after the onset of pain.Some doctors of chiropractic may be surprised that ACA included this recommendation. There are many DCs who are committed to delivery of high-quality patient care that currently take or order X-rays on a majority of their patients because they believe that X-rays are a necessary component of the examination process. There are a number of reasons why this is the case.

*Member-Exclusive Content*A number of systematic reviews have been performed on spinal manipulative therapy (SMT), although their findings have been conflicting. The current review was initiated with the purpose of addressing the divergent conclusions among studies and to include new trials that have been published since the previous reviews. The review’s objectives were to provide updated estimates of the effectiveness and harms associated with SMT compared with other nonmanipulative therapies for adults with acute low back pain.

Long before many of us can remember, there were only two people sitting in the chiropractic treatment room – the patient and the doctor. Gradually, the state licensing boards starting showing up. They were joined by the insurance industry. Then health policy makers like Medicare and Medicaid. Followed by more members of the insurance industry. Then scientists made an appearance, talking about evidence-based clinical practice. Now this already very crowded room may become even more crowded if we open the door to the ever-loudly-knocking performance measurers. We have had time to get at least somewhat used to the state and national boards, insurers, policy makers and even the scientists, to some extent. But what is performance measurement and how might it be beneficial to the practice of chiropractic?

Part of the Evidence in Action series by the Palmer Center for Chiropractic Research

The concept of caring for the whole patient is not new. As early as the 5th century BC, Hippocrates described the importance of attending to the person behind the disease rather than the disease itself. He described psychological, social and physical elements that variously combine and contribute to a person’s health.Assessing and addressing all three components (biological, psychological and social conditions) contributing to health is called a biopsychosocial approach.

Publication bias is a growing problem in evidence-based practice. In the hierarchy of evidence, systematic reviews and meta-analyses lie at the top of the evidence pyramid because they are regarded as the most rigorous form of evidence for possible clinical decision-making. But publication bias can color the results of those reviews and meta-analyses in ways not easily seen nor understood.

Part of the Evidence in Action series by the Palmer Center for Chiropractic Research

The American College of Physicians (ACP) recently released a clinical practice guideline for noninvasive treatments for low back pain. The goal of this guideline is to inform care decisions by systematically evaluating and summarizing available scientific evidence for treating acute, subacute and chronic low back pain. Many treatments used by doctors of chiropractic, such as spinal manipulation, superficial heat, acupuncture, motor control exercise and low level laser are included as recommended first-line treatments.

By now you are no doubt familiar with the concept of evidence-based clinical practice (EBCP). But what does that really mean for the doctor of chiropractic? How does one actually implement the “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of an individual patient” when that individual patient is on the adjusting table? It is not that easy, for a number of reasons.

Representatives of ACA and the Canadian Chiropractic Guideline Initiative together will present a free webinar on guidelines for whiplash-associated disorders on June 20 at 9 pm ET. Presenters Dr. Andre Bussieres, Dr. Joel Weisberg and Dr. Michele Maiers take a moment to share why the topic is relevant to your practice…and why you won’t want to miss this information-packed webinar.

The mission of the Clinical Compass is to provide consistent and widely adopted chiropractic practice information and to perpetually distribute and update this data as necessary so that consumers and others have reliable information on which to base informed healthcare decisions. It is also charged with examining—with a chiropractic lens—all existing guidelines, parameters, protocols and best practices in the United States and other nations.